American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Cardiac dysfunction can prevent successful discontinuation of mechanical ventilation. Critically ill patients may have undetected cardiac disease, and cardiac dysfunction can be produced or exacerbated by underlying pathophysiology. ⋯ Patterns of cardiac function and plasma catecholamine levels differed between patients who did or did not achieve spontaneous ventilation with a trial of continuous positive airway pressure. Cardiac function must be systematically considered before and during the return to spontaneous ventilation to optimize the likelihood of success.
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Except for intravenous therapy, arterial access is the most common invasive procedure performed on critically ill patients. Arterial puncture is a source of pain and discomfort. Intradermal injection of lidocaine around the puncture site decreases the incidence and severity of localized pain when used before arterial puncture. ⋯ Before a plan for behavior modification or policy change is recommended for use of local anesthesia to decrease pain associated with arterial puncture, further research must be done to determine nurses' perceptions of use, actual practice, and currently established local policies.
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Attempts to improve end-of-life care increasingly focus on family-centered care, but few validated assessment tools exist. ⋯ The 3 questionnaires provide a consistent, valid picture of nurses' perspectives on family-centered critical care and may be useful in evaluating family care processes and outcomes and in targeting areas for improvement.
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Randomized Controlled Trial
Effect of continuous display of cerebral perfusion pressure on outcomes in patients with traumatic brain injury.
Clinical bedside monitoring systems do not provide prominent displays of data on cerebral perfusion pressure (CPP). Immediate visual feedback would allow more rapid intervention to prevent or minimize suboptimal pressures. ⋯ The presence of a highly visible display of CPP was associated with significantly better odds of survival and overall condition at discharge.
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The American Association of Critical-Care Nurses Standards for Establishing and Sustaining Healthy Work Environments and the American College of Chest Physicians Patient-Focused Care project are complementary initiatives that provide a road map for creating practice environments where interdisciplinary, patient-focused care can thrive. Healthy work environments are so influential that failure to address the issue would result in deleterious effects for every aspect of acute and critical care practice. Skilled communication and true collaboration are crucial for transforming work environments. ⋯ At best, most likely those efforts will be hit-or-miss and such heroism will be impossible to sustain if the environment is not transformed into a model that reflects standards and initiatives set out by the American Association of Critical-Care Nurses and the American College of Chest Physicians. Other innovative models of care delivery remain unreported. The successes and failures of these models should be shared with the professional community.